Abstract

Background

Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic
variation across neighborhoods. While individual-level risk factors, such as age,
sex, HIV infection, and diabetes have been described, the role of neighborhood-level
factors (e.g., neighborhood HIV prevalence or income) has not been examined.

Methods

To explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations,
a retrospective analysis was conducted using New York City hospital discharges from
2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related
hospitalizations were identified using diagnosis codes and admission information.
Associations were determined by using sex-specific multilevel logistic regression.

Results

The CA-MRSA hospitalization rate varied by more than six-fold across New York City
neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing
in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR]Q5 vs. Q1 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly
twice the odds of residing in neighborhoods with moderately high proportion of men
who have sex with men (MSM) residing in the neighborhood (males: AORQ4 vs. Q1 1.7, 95% CI: 1.1, 2.7; females: AORQ4 vs. Q1 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the
highest quintile (males: AORQ5 vs. Q1 1.2, 95% CI: 0.76, 1.8; females: AORQ5 vs. Q1 1.5, 95% CI: 0.82, 2.7).

Conclusions

Neighborhood-level characteristics were associated with CA-MRSA hospitalization odds,
independent of individual-level risk factors, and may contribute to the population-level
burden of CA-MRSA infection.